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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700795
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:54:48 PM

Document Has Been Signed on 01/15/2025 03:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:EMF FLORES CARE HOME #2FACILITY NUMBER:
342700795
ADMINISTRATOR/
DIRECTOR:
FLORES, ELOISAFACILITY TYPE:
740
ADDRESS:8500 PALLADAY ROADTELEPHONE:
(916) 991-3494
CITY:ELVERTASTATE: CAZIP CODE:
95626
CAPACITY: 4TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Eloisa FloresTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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LPA Hiratsuka, conducted this unannounced annual visit.

This facility has four resident rooms and two staff rooms. All the resident rooms are private. Room five has a full private bathroom. Room four has a direct exit to the outside and room five has a door leading to room four by the direct exit to the outside. Rooms six and three have direct exits to the outside. The main entrance opens to a short hallway that has one staff room directly across. The short hallway leads to the main common area. To the right of the main common area leads to three resident rooms and one staff room. Past the main common area through an opening leads to the kitchen, nook area, and a private resident room that has a direct exit to the outside. There is a sliding glass door that separates the kitchen, nook. and resident room from another common area that is used for activities and in there is also the laundry room. Backyard is well maintained. There is no garage. There is a covered carport.

Three resident files were reviewed
Three staff files were

The following shall be updated and submitted to Community Care Licensing Division by the end of the month
-LIC 308 designation of administrative responsibility
-LIC 500 facility personnel or staff schedule

No deficiencies cited.
Troy OrdonezTELEPHONE: (916) 263-4700
Kerry HiratsukaTELEPHONE: (916) 591-0210
DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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